Inquest finds Joao Carvalho died of misadventure

Portuguese MMA fighter Joao Carvalho died on April 11, 2016, in Dublin, Ireland, due to injuries sustained in a fight with Charlie ‘The Hospital’ Ward at Total Extreme Fighting 1 on April 6. Carvalho lost via TKO in Round 3. He was just 28 years old.

Both fighters were 1-1 at the time of the fight, and it did not appear to be a gross mismatch. Conor McGregor was cageside watching his SBG-Ireland teammate. In an interview with MMA Connect TV, conducted before the fighter fell ill, McGregor said he thought it could be been stopped earlier.

“Your man took some big shots,” said McGregor. “Thought it could have been stopped a little earlier. I feel these referees need to be on the ball a little bit.”

Now an inquest has been completed and determined it was a case of misadventure, an accident that occurred due to a dangerous risk that was undertaken voluntarily. If you slip and fall and die on a sidewalk, that’s an accident. If you slip and fall and die while ice climbing, that’s misadventure. The inquest also recommended the creation of a national governing body for MMA.

The specific cause of death was bleeding inside the skull caused by head injuries, with aspiration of gastric contents as a contributing factor.

Ireland’s RTE reports referee Marius Domasat said Carvalho was never unconscious during the fight, and looked disappointed and tired afterward, but well. Domasat said he would not officiate differently if given the chance to wind back time.

A police witness said Carvalho had received 41 blows to the head. This is not an unusual number. At UFC Fight Night 125, heavyweight Tim Johnson landed 42 significant shots to the head, while opponent Marcelo Golm landed 40. And that’s significant shots, the Irish police likely don’t have the experience to differentiate.

Ward described the fight as close, with plenty of back and forth exchanges. He called it difficult, noting that all fights are difficult. Ward said that after the fight, Carvalho asked for a photo with him and McGregor.

There were three doctors on duty at the event. One, Dr. Ishmael Khan, said he wanted both fighters taken to the hospital for further assessment. Both fighters had gone to the small medical room at the venue, and a short time later Carvalho became drowsy and began to vomit.

He was transported to one hospital, and then another where he underwent an operation that was unable to save his life.

The inquest also heard from Dr. Daniel Healy, neurosurgeon and co-founder of SafeMMA Ireland, a non profit medical organization dedicated to fighter safety. Dr. Healy said he contacted the event promoter Cesar Silva with safety concerns prior to the fatal fight.

“Mr. Silva indicated there was a limited budget for the event and the safety standards required were not possible,” said Dr. Healy.

In response to the inquest findings, Shane Ross, Ireland’s Minister for Transport, Tourism and Sport, has called Irish MMA leaders to establish appropriate governance and safety standards.

“It appears to me that MMA leaders here in Ireland are deliberately dragging their feet on the establishment of appropriate governance and safety standards,” said Ross in a statement. “Today I call on the Irish Mixed Martial Arts Association (IMMAA) to do the right thing – take the steps that are required to safeguard your fighters and prevent needless injury and loss of life.”

“Sport Ireland stands ready to help but can only help if you are willing to ask, and if you are willing to do the right thing. The absence of a National Governing Body (NGB) for MMA in Ireland is unacceptable.

“All sporting organizations in Ireland are autonomous and self-governing. The Irish Government, through its agency Sport Ireland, works with the sports NGBs, to ensure that high standards of safety and governance are understood and put into place. It is absolutely crucial that the sports bodies do everything they can to protect the safety and welfare of their members.

Sports Ireland Chief Executive John Treacy concurred.

“All sports in Ireland self-regulate and what we need is leadership emerging from MMA that takes this responsibility on and self-regulate to ensure that the best standards are in place,” said Treacy on RTE Radio One, as transcribed by Robert Hynes for the Irish Mirror.

Brendan Griffin, the government minister with responsibility for sport echoed the remarks, and said that in the short term, MMA should adopt safety standards used in prize fighting.

It is now almost two years since Joao Carvalho’s passing,” said Griffin. “I am terribly disappointed that there has been so little progress made on establishing appropriate governance arrangements.”

I commend Professor Dan Healy for his vigilance, at his own personal cost in terms of time and money, in pursuing adequate safety standards for MMA. His persistent efforts have resulted in a major improvement in safety standards at MMA events. I would urge MMA leaders to formalise such safety precautions. Such standards could and should be formally backed by MMA in Ireland through the establishment of a National Governing Body, recognized by Sport Ireland.

What is taking so long? Only the IMMAA can answer that.

Every death of an athlete is an extraordinary tragedy. And too, the danger in mixed martial arts has to be viewed within the larger context of death in sports.

American high school football is dangerous. Eleven high school football players died in 2015 alone. Seven athletes have died from injuries sustained while competing in the Olympics – one runner, one cyclist, a boxer, one speed skater, one downhill skier, and two lugers.

Boxing has recorded nearly 1,500 deaths since its inception in the 1700s. Auto racing has killed countless drivers, and spectators are not immune. A single accident in 1955 killed approximately 60 spectators and the driver. 110 school children in Japan died playing Judo in the last 30 years, and hundreds have suffered catastrophic injury.

28 people are believed to have died running, in marathons alone, in the USA alone, from 2000-2009. In 2005, four runners died, in a single event, the Great North Run half marathon in the UK.

Cheerleading in the USA killed 42 between the fall of 1982 and the spring of 2007.

Mixed martial arts is not immune. Eleven people are now believed to have died from injuries sustained during MMA competitions from 1993 to the present.

Douglas Dedge • March 16, 1998 • Kiev, Ukraine • Unregulated • Chief emergency room doctor attributed death to “severe brain injuries.” • First MMA death in the modern era. • Dedge is reported to have passed out in training previous to the fight, and is believed to have had a preexisting medical condition.

Korean identified only as Lee • May 12, 2005 • Samsong-dong, South Korea • Entirely unregulated bout took place in a bar. • Cause of death was heart attack.

Sam Vasquez • October 20, 2007 • Houston Texas • Cause of death was subdural hemorrhage due to blunt trauma of the head, following a KO loss in the third round • First death in a sanctioned MMA event.

Michael Kirkham • June 26, 2010 • Aiken, South Carolina • Regulated bout • Cause of death was subarachnoid hemorrhage of the brain • Kirkham lost his previous fight on April 24 by TKO; Dr. Joe Estwanik believes “this could have been second-impact syndrome.”

Mike Mittelmeier • April 27, 2012 • Bolivia • Unregulated bout allowing face kicks to grounded opponent; there was no ambulance standing by. • Mittlemeier got kicked in the head while attempting a leg lock, illegal under the Unified Rules. • Cause of death was cerebral hemorrhage.

Dustin Jenson • May 24, 2012 • Rapid City, South Dakota • Unregulated bout • Jenson tapped without appearing to take any severe blows. • Cause of death was subdural hemorrhage resulting from blunt force trauma to the head.

Tyrone Mims • August 11, 2012 • Mount Pleasant, South Carolina • Regulated bout • Autopsy results were inconclusive, with no evidence of a concussion or brain trauma detected, no drugs or alcohol detected by toxicology tests. “(Mims) might have had an irregular heart because of some electrical dysfunction,” said Coroner Rae Wooten. “That obviously isn’t seen after death. Once that’s completed, there’s no evidence of that…. There’s just nothing here that explains his death.”

Felix Elochukwu Nchikwo, fought under the name Felix Pablo Elochukwu • April 7th, 2013 • Port Huron, Michigan • Unregulated bout • According to the Michigan coroner’s office, there is “no evidence” that the fighter died from trauma he sustained during an unregulated mixed martial arts match.

Booto Guylain • 24 June 1984 – 5 March 2014 • Johannesburg, South Africa • Unregulated bout • Death was a result of complications related to the swelling of the brain.

Ramin Zeynalov • 29 March 2015 • Azerbaijan • Unregulated bout • Death was a result of brain hemorrhage.

Joao Carvalho • April 11, 2016 • Dublin, Ireland • Unregulated bout • Death was a result of brain hemorrhage.

There are going to be more deaths in mixed martial arts. MMA competition can, like countless other sports, lead to fatality. As such, safety precautions must be adhered to rigorously.